Final Review - 2nd 1/2 of semester Flashcards
Does adrenergic activity increase, decrease, or stay the same as people age?
it decreases
Do autonomic responses increase, decline, or stay the same?
They decline –> autonomic dysfunction
2 CV responses that are altered in geriatric pos d/t blunted B-receptor response
- decreased max HR
- decreased peak EF
What resp factors increase in geriatric pts?
Increase:
- Residual volume
- Closing capacity/closing volume
- FRC
- Dead space
- Vd/Vt ratio
What resp factors decrease in geriatric pts?
Decrease:
- Alv surface area
- Vital capacity (decreases 25 mL/yr starting at age 20)
- TLC
Does cerebral blood flow change in the geriatric population?
Yes, it decreases, along w brain mass
Do neurotransmitters change in the geriatric population?
Yes, they decrease (dopamine), and their receptors are decreased as well
Do dosages for local and general anesthetics change in the geriatric populations?
Yes, both are decreased
How to epidural and spinal durations change in the elderly?
Spinals - increased duration
Epidurals - decreased duration
Do elderly pos have increased or decreased sensitivity to anticholinergics like scopolamine and atropine?
markedly increased sensitivity
How does body fat and muscle mass change in the geriatric population?
Body fat increases - more in women
muscle mass decreases - more in men
Is total body water increased or decreased in the elderly?
decreased
Lipid soluble vs water soluble drug effects in elderly
Water soluble - decreased volume of water –> increased plasma concentrations –> greater effect
Fat soluble - increased volume of distribution –> lower plasma concentrations –> decreased effect
T/F: In the elderly, myocardial depressant effects of anesthetics are exaggerated while the tachycardia response is decreased.
True
3 reasons the elderly take longer to wake up from anesthesia
- increased body fat
- decreased hepatic
- decreased pulm gas exchange
5 criteria for c/spine injury
- neck pain
- severe distracting pain
- any neurological s/s
- intoxication
- loss of consciousness at scene
What acid/base imbalance to trauma its experience after massive transfusions?
metabolic alkalosis
also remember hyperK w massive transfusions
If transfusion rate exceeds ___ unit(s) q _____ min, you can see cardiac depression caused by _______
1 Unit
5 min
hypocalcemia
How can a hemolytic transfusion reaction be recognized in an anesthetized pt?
- increased temp
- tachycardia
- HoTN
- hemoglobinuria
- oozing at field
Common cause of bleeding after massive transfusions
dictional thrombocytopenia
half life of crystalloids and colloids
crystalloids - 20-30 min
colloids - 3-6 hrs
What crystalloid is more likely to cause hyperK acidosis and can aggravate cerebral edema when given in large volumes? LR or NS
LR
cerebral edema - it is slightly hypotonic
Why do hypovolemic pos need less anesthetic?
alv conc’n is increased in shock pos r/t decrease in CO and increased ventilation
IV anes - smaller intravasc volume –> IV anesthetics are exaggerated
What is cushings triad and what does it indicate?
- HTN
- Bradycardia
- Resp disturbances
- late signs of brain herniation
What is Beck’s Triad? What does it indicate?
- Neck vein distention
- HoTN
- Muffled heart tones
- cardiac tamponade - NO PROPOFOL!!!!!! - use etomiade =)
An astute anesthetist should watch for ______ during a pericardialcentesis to indicate when the needle has gone too far into myocardial tissues
EKG changes
What can an anesthetist expect to occur on incision when an abd trauma pt undergoes an ex lap?
HoTN
Fat embolism labs
- elevated serum lipase
- fat in urine
- thrombocytopenia
4 ways an anesthetist can control intracranial HTN
- fluid restrictions
- diuretics (mannitol)
- Hypocapnia (CO2 26-30)
- DON’T GIVE KETAMINE
high cord injury –> spinal shock –> loss of sympathetic tone –> ??
- HoTN
- Warm to touch
- bradycardia
- areflexia
- GI atony
Is succs ok for an autonomic hyperreflexia pt?
It sure is =)
Tx for simple vs tension PTX
Simple - chest tube 4th or 5th intercostal space (air is in the parietal and visceral pleura; lung collapses)
Tension - 14# needle at 2nd intercostal space midclavicular line then chest tube like for a simple (air is in pleural space, is trapped, and increases w insp but doesn’t escape w exp)
You are in the OR and the alarms on the anesthesia machine are going off constantly. What is going on and what do you need?
ARDS .: poor lung compliance
Need high airway pressures/a better vent w higher gas flows
